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Contracts and the things that go unsaid

So, it’s official. The new junior Dr contract will be imposed from August of next year.

Trying to work out what that means for us as trainees is complex because there’s been a lot of rhetoric from both sides. Unfortunately, most of this has focused on the financial implications for junior doctors, rather than working conditions.

Why does this matter? It matters because I see a continual stream of people saying that healthcare professionals need to be resilient; that self-care is important for us to be compassionate; that a happy workforce is one that cares for patients…

It’s hard to see how that is compatible with the new contract. Reading NHS Employers’ summary of the proposals. it’s hard to see what the fuss is about. Yes, the “social” hours limit will increase, but basic pay should increase… What’s the problem?

The problem is with all the things that aren’t acknowledged; that we just accept as an extra part of the job. The things that we’ve just done because that’s how medicine works… And yes, the money does help with that.

If you’re a junior doctor, you know exactly what I mean. There are the working conditions that are already supposed to be protected and agreed… but that somehow don’t quite work in practice.

It’s the electronic monitoring of hours that’s supposed to make sure that we get breaks & work safe limits… but that doesn’t seem to be monitored itself.

It’s the moving around the region with six weeks notice – not really enough time to sort out a new nursery placement or to find a place to live – that isn’t always six weeks.

It’s the guarantee that your rota will be available six weeks before you start this new rotation, but that somehow isn’t ready until 72 hours before your shift starts.

It’s the knowledge that I have a study budget each year, but that it doesn’t cover the cost of doing one life support course (which, unsurprisingly, is mandatory).

It’s the £7000+ that I ended up spending in one year, just to keep up with all the things that are supposed to be covered in my training. (And I’m not in a craft speciality like surgery – they have really expensive training courses)

It’s the extra hours that we spend at work but never report (see monitoring above); the days that you come in to check your clinic letters are ready; the phone calls to the ward at 3am to make sure things are OK…

It’s the audits and guidelines that don’t really make it into the working day, but still need to get done.

It’s the meetings that we can only arrange after 5pm; the expectation that we will stay late (in complete defiance of Athena SWAN guidance) because there’s no way that we can all get together during the working day…*

It’s hard to see how the new contract is going to address any of this (and yes, some of it is stated in the DDRB recommendations… but as I said, this is the stuff that’s supposed to be happening anyway).

Is it about the money? Kind of. But the money isn’t what’s going to affect patient care. Not having robust safeguards will